POS1381 TRANSIENT PERIVASCULAR INFLAMMATION OF THE CAROTID ARTERY (TIPIC) SYNDROME: A RARE CAUSE OF CAROTIDYNIE
Authors: C. Porpaczy, C. Zimmermann, R. Steinbach, K. Redlich
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Carotidynie defines localised, unilateral neck pain in the region of the carotid bifurcation and is a relatively frequent event with a myriad of causes. Differential diagnosis include mainly arterial dissection, large vessel vasculitis or local inflammation or surrounding structures (e.g. lymphadenitis). We herein describe a patient with carotidynie caused by a TIPIC syndrome under follow up by ultrasound imaging. <h3>Methods</h3> The logiq S8 from GE2 with 2 different linear probes was used. GE L8-18i-D Hockey Stick probe. ML 6-15-D Matrix probe. <h3>Case presentation</h3> A 36 year old male patient was referred to our rheumatological outpatient department because of localized pain in the left lateral part of the neck, which persisted over two days. Swallowing of fluids or solid food was painful, but unimpaired. The patient mentioned no recent trauma, but he reported symptoms of an upper respiratory tract infection, without fever, two weeks before. Clinical investigation showed no signs of local swelling or palpable lymph nodes. ENT consultation ruled out inflammatory processes causing the symptoms including tonsillitis, pharyngitis or laryngitis. Analgesic treatment with tramadol was not effective. Laboratory investigations revealed slightly increased CRP and Erythrocyte Sedimentation Rate (ESR) values. ANA and subsets, as well as ANCA were negative. An ultrasound of the region showed a localized swelling of the media and adventitia of the left common carotid artery, involving half of the circumference over a length of 4 mm. Multiple lymph nodes with signs of inflammation were present on both sides of the vessel. No dissection or stenosis was detectable. Due to a typical clinical presentation and ultrasound appearance without carotid stenosis, typical lokalisation at the distal part of the carotid communis artery the diagnosis of carotidynie or TIPIC was made. Treatment with nonsteroidal antirheumatic drugs was initiated without any effect. Therefore, we initiated a treatment with steroids (0,3mg/kg body weight). 3 days after the beginning of the therapy the before unbearable pain nearly resolved. A MRI angiography of the vessel performed 5 days after the inition of the steroid treatment showed an eccentric wall thickening with diameter of 5 mm near the bifurcation of the common carotid artery, with a slightly increased enhancement of the carotid wall, but no further inflammatory structures. Awareness of this syndrome and its excellent visualization for diagnosis, exclusion of other pathologies and follow up by high resolution ultrasound could be useful to reassure patients about the benign nature of this syndrome and help the clinician to avoid more invasive imaging modalities. <h3>Conclusion</h3> The disease is first reported by Fay in 1927. Despite only a few case reports are available in the last 20 years and mostly one case only is reported. Usually an inflammatory process is suspected. Although a rare event sonography is capable to diagnose such vessel abnormality with high precision. Treatment with NSAIDs and, if not sufficient, eventually steroids are required. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.